With the opioid epidemic showing no signs of ceasing, drug manufacturers are working to get the next generation of safe painkillers on the market. Analysts estimate that the US spends $4 billion annually on opioids for pain relief. While many people who experience pain have reason to be on opioid medications at some point, health care industry and public health stakeholders are searching for alternative solutions to alleviate pain, since more than 17,000 Americans died from prescription opioid abuse in 2015, according to the Centers for Disease Control and Prevention (CDC).
Drugs such as morphine, fentanyl, and oxycodone have been shown to effectively block pain signals by acting directly on the brain. However, they can be highly addictive. Some patients may find relief in other ways. Some hospitals are encouraging use of non-narcotics and advanced pain management strategies when clinically appropriate. Other solutions include educating physicians about the extent of the problem, and providing data on how their prescribing patterns compare to their peers.
Some pharmaceutical companies are working to create medications that are more tailored for different types of pain. These new drugs are drawing from products like chili peppers and cannabis, which have pain-modifying characteristics. Others are studying human genetic mutations that alter how people experience pain to design new treatments for the 100 million individuals across the country who experience chronic pain. Some potential therapies are nerve-growth factor inhibitors, which block pain signals in nerve cells beyond the brain, such as in the skin and muscle. Researchers are also studying rare genetic mutations that prevent people from feeling pain, to identify pathways in the body that may be triggered to ease pain. One medication in development comes from a deadly toxin found in cone snails. While many conditions cause pain, many pharmaceutical companies are interested in targeting osteoarthritis pain, a growing market as the baby-boomer generation ages.
Opioids probably will not completely disappear from the market despite new medications being developed. Some are very effective at targeting unrelenting pain for patients who may not find relief otherwise. Some companies are working on opioids that are safer and less addictive. For example, a drug that crosses the blood-brain barrier more slowly than a typical opioid on the market now may result in a lower euphoric and less addictive effect. The downside is that the slower entry will not be adequate to treat acute pain, but it could be effective in treating chronic pain.
Related: In an analysis by STAT, the death toll from opioid addiction could spike from 100 to 250 deaths a day, if current use-trends continue and the wait time for treatment remains. However, STAT projects that fatal overdoses could fall below 22,000 a year by 2027 if doctors limit opioid prescriptions, states use prescription drug monitoring programs and insurers increase access to addiction treatment. This would require a major public investment in evidence-based treatment options.
Some potential good news: New CDC Data published last week shows that the number of opioid prescriptions in the US peaked in 2010 at 81.2 prescriptions per 100 people, and started to decrease by 13 percent in 2012. High-dose opioid prescriptions declined faster, more than 41 percent from 2010-2015. Though the trend is positive, the agency emphasizes that the data indicates too many opioids are being given out.
Last month, the HHS announced the availability of $195 million in a new funding opportunity for community health centers to expand access to mental health and substance abuse services focusing on the treatment, prevention and awareness of opioid abuse in all 50 states. Health centers that receive an award – to begin as early as September – will use the funds to increase resources dedicated to mental health and substance abuse services, including staff, health information technology, and training.
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